Treating kala azar-HIV co-infection in Bihar, India
International Activity Report 2018


MSF in India in 2018 Healthcare remains a challenge for millions of people in India, due to a combination of poverty, social exclusion and an over-burdened public health system.

Médecins Sans Frontières (MSF) continues to work in India with vulnerable communities, providing medical care linked to infectious diseases, mental health, sexual violence and malnutrition. 

Treating drug-resistant tuberculosis (DR-TB) and HIV in Mumbai 

Mumbai’s M East ward is one of the areas with the highest rates of TB in India’s most populous city. For the last 10 years, MSF has worked in an independent clinic that offers comprehensive care for HIV and DR-TB patients – including those with very complex drug resistance patterns that require treatments not available elsewhere in the public or private sector.  

In collaboration with the national TB programme and the local government, we also run an outpatient TB department at Shatabdi hospital in M East ward. Many of our TB patients have developed resistance because they have been receiving ineffective treatment for years; others are directly infected by extensively resistant strains. Our model of care provides less toxic and more effective treatments for DR-TB, using newer drugs and offering psychosocial assistance to improve adherence to treatment.  

Our teams work in the community to strengthen case finding and adherence to treatment. In 2018, we launched an initiative to ensure systematic clinical and psychosocial follow-up of DR-TB patients at seven health posts, with the objective of demonstrating a replicable model of community-based care. 

Specialised care for TB, HIV and hepatitis C in Manipur 

Manipur has a high prevalence of HIV, hepatitis C and both drug-sensitive and drug-resistant TB. Due to a lack of healthcare resources, it also has a high incidence of co-infection, which means each disease speeds up the progress of the other, making patients more vulnerable and treatment more difficult.  

Through clinics in Churachandpur, Chakpikarong and Moreh, near the Myanmar border, our teams offer screening, diagnosis and treatment, as well as counselling and health education about how to get tested and treated.  

In 2018, we increased our support to Churachandpur district hospital, to improve treatment for HIV patients co-infected with hepatitis C. We also started using bedaquiline to treat patients with extensively drug-resistant TB.  

Hepatitis C project in Meerut, Uttar Pradesh 

Western Uttar Pradesh has a very high prevalence of hepatitis C, a potentially fatal disease that can lead to liver failure and liver cancer if left untreated. We have been running a pilot hepatitis C project in Meerut since January 2017, in collaboration with the National Health Mission.

The aim is to demonstrate the effectiveness of decentralised and simplified hepatitis C treatment and care, and to share best practices for replicating the model in other high-prevalence areas. We provide testing, treatment, health education and counselling at a district hospital. 

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